视频脑电图在新生儿惊厥中的应用价值

Value of video electroencephalogram in the identification of neonatal epileptic and non-epileptic seizures

目的评价数字化视频脑电图(videoelectroencephalogram,VEEG)在新生儿惊厥中的应用价值。方法应用数字化视频脑电图仪,对64例胎龄28-44周的新生儿惊厥发作进行VEEG监测并分析结果。结果正常脑电图43例(67．2％),异常脑电图21例(32．8％),其中以新生儿缺氧缺血性脑病、颅内出血等脑器质性病变癎性放电异常率最高。其中发作期癎性放电者13例;发作间期癎样放电3例,背景节律正常;背景节律改变伴有发作间期癎样放电2例;背景波改变3例,其中低电压1例,平坦波1例,交替现象消失1例。睡眠期癎性放电的放电频率比清醒期明显增高,且以安静睡眠期最为多见。18例VEEG同步监测到发作期癎性放电,其中16例(16／18)起始放电为局灶起源,以颞区为主(13／18)。共监测到46例新生儿发作,在发作期或／和发作间期VEEG检测均无癎性放电,确定为非癫癎性发作。结论VEEG对于新生儿惊厥发作性疾病的诊断和鉴别诊断具有重要价值,有利于早期治疗和改善预后。

Objective To evaluate the clinical effectiveness of video electroencephalogram （VEEG） in neonatal seizure. Methods Seizures attacks of 64 newborns with gestational ages 28 44 weeks were monitored by VEEG. Results Incidence of abnormal VEEG was 32.8%. Among 64 cases found in the VEEG, 13 cases had epileptic discharge in the ictal VEEGs. Three cases showed epileptic discharge＇ in the interictal VEEGs with normal background rhythm. Two cases presented epileptic discharge in the interictal VEEGs with abnormal background rhythm. Three cases had abnormal background rhythm only. Discharge frequency during sleeping was more quick than that during awakeness,mostly in the quiet sleep phase. Most frequently ictal epileptic discharges were a focal onset （16/ 18）, and 13 cases happened in the temple lobe. No epileptic discharge in the ictal and interictal VEEGs were tested in 46 cases attacked with seizures, which were diagnosed as non-epileptic seizures. Conclusions VEEG plays an important role in the diagnosis and differential diagnosis in epilepsy and non-epileptic seizure in newborns, and is valuable to perform early to improve prognosis.